Healthcare Trends 2019



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DNA and insurance premiums

Genetic testing is invaluable in predicting health disorders and tailoring treatment best suited to the patient's DNA, and, although South Africa isn't there yet, it can play a role in determining your insurance premiums.
Britain's chief medical officer, for example, calls for “genetic testing to be routinely offered to cancer patients to help select the most effective treatment". This is according to a recent article published on Sky News where research suggests that in 60% of Britain’s cancer cases, the genomes of cancer patients reveal “actionable” data which can shape the future of precision treatments.

It therefore comes as no surprise to read about scientists who are able to determine, via genetic testing, if an individual has a high probability to develop Huntington Disease. Even more astounding is the fact that scientists from Georgetown University Medical Centre in the US can determine, via a simple blood test, if a person is likely to develop dementia within three years from when the test was conducted according to their research findings that were published in the Nature Medicine journal. According to them, the differences in a person’s blood biomarkers may signify the early stages of Alzheimer’s disease – a condition which affects 35-million people wordwide.

Hence, young women with a predisposition to breast cancer can now benefit from early detection using an imaging scan called the digital infrared thermal imaging (Diti) method. These cameras are similar to those used at airports to scan travellers although the software used is different. Traditional methods of diagnoses, like mammograms, often detect cancer at a fairly advanced stage. This technology can detect most breast disorders at an early stage.

Reflecting on what is available out there makes it difficult to comprehend that these breakthroughs are even possible. However, this is not science fiction but a reality of our time. Looking at all the possibilities that emerge from these scientific and technological developments, one cannot help but think about the impact that this might have on the life insurance industry.

What this means to the insurance industry

Unlike other countries including the States and Britain, genetic testing is not a component of the long-term insurance industry’s current underwriting processes in South Africa.

However, during 2009, the Association for Savings and Investment South Africa (ASISA) released a standard for genetic testing. This stipulated that an insurer is obligated to review the terms of a policy if an applicant provides the results of a predictive genetic test. Furthermore, when assessing an individual’s risk profile, the insurer should take the value of specialist surveillance, medical intervention and successful treatment into consideration.

In addition, the insurer may not request an applicant to undergo a genetic test to support an application for insurance, whether this is in order to obtain a lower than standard premium rate or to indicate the presence or absence of a suspected genetic condition.

Although these standards are not legally binding, support for the various parties is provided through the Long-term Insurance Ombudsman, whose role includes mediating disputes between insurers and the insured life. This includes cases where there is a concern of genetic discrimination or adverse selection.

“We do not foresee sending clients for genetic testing, but there might be instances where clients do specific genetic tests to prove they are a lower risk than what we attribute to them based on their family history. But those tests are done voluntarily and initiated by the client," says George Kolbe, head of marketing for life insurance at Momentum.

“Our underwriting research and development unit, in collaboration with our product development team, is focused on keeping abreast with changes in the medical/insurance arena and on finding ways to pass the benefit of any learning on to our clients. Also, industry underwriting practices are regulated by the ASISA and as a result we adhere to their standard.”

Genetic discrimination

“Genetic testing is not undertaken lightly and is normally only done after extensive counselling where physical signs and symptoms of a disease exist or where a risk for developing a disease exists. This is most often suggested in the client’s family history. Momentum’s normal underwriting practices will scrutinise a client’s family history and the information will be utilised as a proxy to determine the probability of developing any hereditary medical conditions," explains Janet Brodie-Thompson, chief underwriting officer for product development at Momentum.
“We do expect clients who have had genetic testing done to disclose this to us and also to divulge the result but we will not request a client to have a genetic test done.”

From a consumer perspective, numerous fears can crop up regarding genetic testing once the test results have been disclosed to an insurer. These may include the fear of genetic discrimination that limits access to insurance by ways of medical underwriting, impacting the claims process, sacrificing privacy regarding medical information as well as affecting affordability of cover.

"Herein lies the dilemma: genetic testing and other new-generation tests impacts on an ethical, regulatory, social, constitutional and emotional level and leaves us with the burning question: “In this day and age of revolutionary medical testing and technology, how does one find a balance of fairness for both the insured life and the insurer?” concludes Kolbe
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